Traditional hand-assisted laparoscopic surgery (or HALS) combines conventional minimally-invasive laparoscopic surgical techniques with those of classical open field surgery. More specifically, by the laparoscopic approach, through application of trocars (generally speaking, three access points) for the introduction of instruments used during surgical intervention by a laparoscope (either of the optical fiber type or those equipped with a CCD camera), a surgeon can visually access and maneuver relevant inner portions of a patient's abdomen. The diameter of the incisions made is typically between about 5mm and about 25 mm. Through insufflation of an inert gas, a working space, known as a pneumaperitoneum, is then created in the abdomen. This enables the surgeon to operate readily, without hindrance due to a lack of adequate space. In addition, an incision about 5-7 cm long is made near the first access points or incisions, through which the surgeon may introduce his/her generally non-dominant hand into the patient's abdomen and perform support operations (such as tissue displacement, retraction of organs to be operated on, palpation, interaction with other instruments, etc.).
To prevent loss of pneumaperitoneum through the incision(s), several types of sealing devices have been developed. These devices are intended to be applied to an incision so as to allow passage of the surgeon's hand therethrough, while preventing gas from escaping. Currently available sealing devices are of several types, for instance, either those having an adhesive flange to be secured to the abdominal wall or devices of an inflatable type. A conventional sealing device of the inflatable type that is considered especially comfortable and easy to use is one having a substantially tubular inflatable sleeve, with a twisted inner cross section, for providing a seal against the surgeon's arm once her/his hand has been inserted through the sleeve. The device also has a pair of sealing rings for closing the innerside and the outerside of the abdominal wall corresponding to the incision.
Hand-assisted laparascopic surgery has been successfully applied to a wide range of surgical procedures for example gastric resection, gastric by-pass, transhiatal esophgectomy, pancreatic and hepatic surgery, nephrectomy, colorectal surgery, aortic aneurysm repairs, etc. The main advantages of this technique as compared to conventional laparascopic surgery is that the surgeon retains both (i) direct tactile sensation of traditional surgery, which is not provided by modern, remotely controlled instruments, and (ii) the hand-eye coordination lost previously when surgeons began perfoeming surgery through a monitor. Furthermore the presence of the surgeon's hand in the surgical field enables greater ease in, and atraumatic displacement of, the organs, an immediate control of potentially dangerous situations, and gives him/her the ability to perform blunt dissections. In addition, the facility provided by use of an assisting hand makes the surgeon's task easier to perform, thereby reducing the level of training and experience usually required to master laparoscopic surgery techniques.
However, in the course of hand-assisted laparoscopic surgery, situations often occur where the surgeon's dexterity is no longer adequate to perform extraordinarily precise operations such as fine dissections, vascular peduncula isolation, limphade-nectomy, etc. In conventional open field surgery, when tissue to be grasped is only a few millimeters in size such that the surgeon's finger tips can be ineffective, the use of forceps, which is generally operated by the surgeon's non-dominant hand, is not problematic. During minimally invasive procedures, on the other hand, such as hand-assisted laparoscopic surgery, the use of conventional surgical forceps has not been possible. This is because of their shape, incompatibility with the space available in the surgical field, and the manner in which this type of minimally invasive intervention is carried out, namely, a need to minimize the number of times the non-dominant hand is extracted from and re-inserted into the surgical field.